| NPI | 1124327739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 19630) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GU RE2422) |
| 363LF0000X Nurse Practitioner, Family (Licence: GU NP0180) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2024-06-14 |